=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457430480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS. CHERMAK AND HANSON, A N.C. GENERAL PARTNERSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1564 N PEACE HAVEN RD
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27104-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-760-1491
-----------------------------------------------------
Fax | 336-760-3944
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1564 N PEACE HAVEN RD
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27104-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-760-1491
-----------------------------------------------------
Fax | 336-760-3944
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. DAVID S CHERMAK
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 336-760-1491
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 7050
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------